Provider Demographics
NPI:1942801584
Name:KINETIC EDGE FOOT & ANKLE LLC
Entity Type:Organization
Organization Name:KINETIC EDGE FOOT & ANKLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:S
Authorized Official - Last Name:KLIMEK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:908-873-8171
Mailing Address - Street 1:4 QUINE ST
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-3130
Mailing Address - Country:US
Mailing Address - Phone:908-499-3956
Mailing Address - Fax:908-276-8765
Practice Address - Street 1:379 MAIN AVE STE 3
Practice Address - Street 2:
Practice Address - City:WALLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07057-1829
Practice Address - Country:US
Practice Address - Phone:201-655-6617
Practice Address - Fax:201-655-6618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty